Term
| of the 9 million people in the US with angina, _____ are actually being treated. |
|
Definition
|
|
Term
| what is the cause of angina? |
|
Definition
| an imbalance between oxygen supply and demand |
|
|
Term
| how could you distinguish heart burn and angina? |
|
Definition
| angina occurs when you are exerting yourself and can be subtle |
|
|
Term
| what is VO2? is myocardial VO2 high at rest? |
|
Definition
the body's ability to extract and get oxygen
near max even at rest |
|
|
Term
| what do medications have a general affect on the body's oxygen supply and demand? |
|
Definition
| increase supply and reduce demand |
|
|
Term
| what is angiogenesis? when will this occur? are there drugs that can help? |
|
Definition
sprout new blood vessels that will bypass a blockage
takes years to occur
making drugs that will induce this |
|
|
Term
| with coronary blood flow, what causes chest pain? |
|
Definition
|
|
Term
| with coronary vascular resistance, how do drugs help relieve chest pain? |
|
Definition
|
|
Term
| what is diastolic filling time? how can you increase this? what kind of drug? |
|
Definition
the time it takes for the left ventricle to fill with blood
increase diastole by decreasing HR
beta-blockers |
|
|
Term
| what effect does increasing HR have on oxygen demand? |
|
Definition
|
|
Term
| what are the four features of myocardial blood flow? |
|
Definition
1)5% of cardiac output
2)diastolic flow greatest
3)extraction of oxygen about 75% at rest
4)flow controlled by autoregulation |
|
|
Term
| what are the four determinants of oxygen supply? |
|
Definition
1)coronary blood flow
2)vascular resistance
3)collateral blood flow
4)diastolic filling time |
|
|
Term
| what are the four determinants of oxygen demand? |
|
Definition
1)heart rate
2)contractility
3)afterload
4)preload |
|
|
Term
| if you ____ preload, you will _____ oxygen demand. |
|
Definition
|
|
Term
| what are the three different types of angina? |
|
Definition
vasospastic angina
exertional angina
partially occlusive transient platelet thrombus |
|
|
Term
explain vasospastic angina.
typical or atypical?
is this associated with exertion?
can drugs help this? |
|
Definition
spastic contraction of SMC that clamps down on the coronary artery and reduces blood flow
atypical
no
yes |
|
|
Term
explain exertional angina.
will drugs help this angina? |
|
Definition
slow progressive narrowing of the blood vessel due to atherosclerosis which causes a reduction in blood flow that results in typical angina during exertion
yes |
|
|
Term
explain partially occlusive transient platelet thrombus angina.
will anti-anginal drugs help this? if not, what will? |
|
Definition
plaque will throw a clot, which causes pain and then the clot breaks up
no, but a blood thinner will |
|
|
Term
| what are treatment strategies for angina? |
|
Definition
behavior modification
nitrates
calcium channel blockers
beta-blocking agnets
surgical (angioplasty, CABG) |
|
|
Term
what is nitroglycerine's effect on the arteries?
what won't it affect?
what are the side effects? |
|
Definition
dilation
the 10-15% of the population that already have dilated arteries
headaches |
|
|
Term
| Nitrates are exclusively used for angina, they dilate the veins and arteries, which causes what? and then what? |
|
Definition
reduction in preload-> lowers oxygen demand
decreased blood pressure->reduces oxygen demand
increase c-GMP->relaxation of SMC
decreased contractility->lowers oxygen demand |
|
|
Term
| T/F in 85%-90% of people nitrates cause vasodilation, which increases oxygen supply. |
|
Definition
|
|
Term
| T/F nitrates decrease blood pressure, which decrease oxygen demand and ultimately decrease heart work. |
|
Definition
|
|
Term
| T/F nitrates increase filing pressure, which decreases heart work. |
|
Definition
false
decreases filling pressure to decrease heart work |
|
|
Term
| if a healthy individual were to take a nitrate, what would happen? |
|
Definition
| it would reduce ability and performance |
|
|
Term
| in relation to exercise, what do nitrates do for someone with angina? |
|
Definition
allow the individual to workout longer and harder before the onset of angina
increase exercise performance |
|
|
Term
| what are the side effects of nitrates? what is the cause of each side effect? |
|
Definition
headaches by dilation of the blood vessels in the brain
dizziness by orthostatic hypotension
reflex tachycardia by reflex activation of the sympathetic neurons in a response to a drop in BP |
|
|
Term
| what is orthostatic hypotension? |
|
Definition
| less blood is pumped to the brain which can cause fainting |
|
|
Term
| any medication that decreases HR or systolic blood pressure will _____ oxygen demand. |
|
Definition
|
|
Term
nitrates affect oxygen supply by:
____coronary blood flow,
____vascular resistance,
____collateral blood flow, and
____diastolic filling time. |
|
Definition
increase
decrease
increase
decrease |
|
|
Term
nitrates affect oxygen demand by:
___heart rate,
___contractility,
___afterload, and
___preload. |
|
Definition
increase
increase
decrease
decrease |
|
|
Term
| what is the major affect of nitrates? |
|
Definition
|
|
Term
| nitrates dilate the coronary arteries which causes___? |
|
Definition
| an increase in the blood supply |
|
|
Term
| what are the two beneficial effects of nitrates for treatment of vasospastic angina? |
|
Definition
1)relaxation of the coronary artery spasm which increases the blood flow to the heart muscle
2)reductions in preload and afterload |
|
|
Term
| what are nitrates prescribed for? |
|
Definition
|
|
Term
| what are the major uses of calcium channel blockers? |
|
Definition
angina
hypertension
arrhythmias |
|
|
Term
| what does the heart use make a more forceful contraction? |
|
Definition
|
|
Term
| what is the mechanism of action of calcium channel blockers? |
|
Definition
| inhibit the movement of calcium from the extracellular fluid into the intracellular fluid by blocking the channels |
|
|
Term
| what affect does calcium channel blockers have on vascular smooth muscle? |
|
Definition
|
|
Term
| what affect do calcium channel blockers have on cardiac muscle? what can too much do? |
|
Definition
slow down electrical signal to the AV node and decrease the contrail state of the atrial and ventricular muscles
cause cardiac depression |
|
|
Term
calcium channel blockers affect oxygen supply by:
___coronary blood flow and
___vascular resistance. |
|
Definition
|
|
Term
| calcium channel blockers affect oxygen demand by ____ after load and contractility? |
|
Definition
|
|
Term
| what are the side effects of calcium channel blockers? |
|
Definition
dizziness
headache
cardiac depression (rare) |
|
|
Term
| T/F it is commonly seen for pair a calcium channel blocker with a beta blocker. |
|
Definition
|
|
Term
| how do beta blockers work? |
|
Definition
| block the beta receptor for sympathetic nerves, specifically beta1 |
|
|
Term
| what would be the effect if you were to block the Beta2 receptors on the veins and arteries? |
|
Definition
| there would be little to no effect because the Alpha1 receptor is important on the blood vessels |
|
|
Term
| what are non-selective beta blockers? |
|
Definition
| block both beta 1 and 2 receptors |
|
|
Term
| what are selective beta blockers? |
|
Definition
| just target the beta1 receptors |
|
|
Term
| what are the major uses of beta blockers? |
|
Definition
angina
arrhythmias
hypertension |
|
|
Term
| T/F blocking the beta-receptors within the heart leads to an increase in heart rate and contractility. |
|
Definition
|
|
Term
| Beta blockers _____ the work load and thus the demand for oxygen by the heart. |
|
Definition
|
|
Term
| T/F if you decrease HR, you will increase diastolic filling time, and increase oxygen supply. |
|
Definition
|
|
Term
| how do beta-blockers help with exercise? |
|
Definition
| higher exercise levels can be attained before the patient experiences angina |
|
|
Term
| T/F it is uncommon for beta-blockers to be paired with nitrates. |
|
Definition
|
|
Term
| what do beta blockers decrease your risk of? |
|
Definition
decrease sympathetic activity which decreases arrhythmias
may reduce congestive heart failure |
|
|
Term
| if you just have high blood pressure and you are taking a beta blocker what will this increase your risk for? |
|
Definition
|
|
Term
| what are the side effects of beta-blockers? |
|
Definition
headache
orthostatic hypotension
erectile dysfunction
increase triglycerides
decrease HDL levels
bronchiospasm
masks symptoms of hypoglycemia
cause differential AV block |
|
|
Term
| what are the uses of diuretics? |
|
Definition
|
|
Term
| what is the action of diuretics? |
|
Definition
| altering renal function resulting in an increased excretion of electrolytes and fluid |
|
|
Term
| Diuretics help individuals with coronary artery disease because of what? |
|
Definition
| reduction of blood pressure and venous return which reduces the work of the heart and ultimately reduces oxygen demand |
|
|
Term
| T/F diuretics help exercise. |
|
Definition
false
they do not influence the exercise capacity but rather produce a toxic affect that may show on the EEG. |
|
|
Term
| vasodilators are primarily used for the treatment of ____. |
|
Definition
|
|
Term
| vasodilators cause the relaxation of SMC which causes what? |
|
Definition
| reduction of blood pressure |
|
|
Term
| what are ACE inhibitors used for? |
|
Definition
| treatment of hypertension |
|
|
Term
| what controls long term blood pressure regulation? |
|
Definition
|
|
Term
| explain how angiotensinogen becomes active. |
|
Definition
-renin is released when the sympathetic nerves are active, which cuts angiotensinogen into angiotensin 1 (inactive)
-as angiotensin 1 circularities ACE changes angiotensin 1 to angiotensin 2 (active)
-angiotensin 2 binds to the blood vessels and causes vasoconstriction, which increases blood pressure
-angiotensin 2 also causes adrenal glands to secrete aldosterone which causes the kidneys to retain sodium, which increases blood pressure |
|
|
Term
| what three drugs affect the Renin Angiotensin Aldosterone System? |
|
Definition
ace inhibitor
angiotensin 2 binding blockers
aldosterone receptor blockers |
|
|
Term
| how do ACE inhibitors work? |
|
Definition
| block conversion of angiotensin 1 to angiotensin 2 |
|
|
Term
| how do angiotensin 2 binding blockers work? |
|
Definition
| blocks the binding of angiotensin 2 to the blood vessel |
|
|
Term
| how do aldosterone receptor blockers work? |
|
Definition
| block aldosterone receptors in the kidneys |
|
|
Term
| in a patient that has had a heart transplant, why would a longer warm up be appropriate? |
|
Definition
| the nerves are cut therefore HR will take longer to increase to meet demands because hormones take longer to exhibit effect |
|
|
Term
| if your goal is to calculate net calories what should you do? |
|
Definition
| leave off the 3.5 from the beginning equation when calculating VO2 |
|
|
Term
| 1 watt is equal to ___kgm/min |
|
Definition
|
|
Term
| what are the mechanism of action for nitrates? (Hint:3) |
|
Definition
reduces venous return and end-diastolic volume
dilates the coronary arteries
reduces SBP |
|
|
Term
| T/F ACE inhibitors are not effective in decrease BP when paired with a calcium channel blocker. |
|
Definition
|
|
Term
| elevated levels of aldosterone are associated with what? |
|
Definition
vasotoxicity
CHF
renal disease |
|
|
Term
| what are the primary uses of Digitalis? |
|
Definition
increase myocardial contractility
reduces supraventricular arrhythmias |
|
|
Term
| T/F the correct dosage of digitalis is easy to find. |
|
Definition
|
|
Term
|
Definition
| opens calcium channels in people with weak hearts |
|
|
Term
| what is the issue with anti-coagulants? |
|
Definition
| you could potentially bleed to death |
|
|
Term
|
Definition
anti-inflammatory
anti-coagulant |
|
|
Term
|
Definition
reduce intraplaque lipids
stabilize atherosclerotic plaque
improve vasomotor function
anti-inflammatory |
|
|
Term
| how do you find a percent of VO2R? |
|
Definition
resting Vo2= 3.5 ml/kg/min
subtract resting from max is the VO2R
then multiply by % |
|
|
Term
| what are the goals of a cardiac rehabilitation program? |
|
Definition
1)increase caloric expenditure
2)improve aerobic fitness
3)maintain or improve functional ability
4)increase muscular strength
5)improve vocational or recreational performance
6)optimize ability to perform ADLs
7)MAINTAIN INDEPENDENCE |
|
|
Term
| T/F initial exercise Rx for a cardiac rehab patient should be based on risk stratification. |
|
Definition
|
|
Term
| a graded exercise test should be performed when dealing with patients with cardiac disease in order to: |
|
Definition
assess functional capacity to aid in risk stratification
identify problems and effectiveness
evaluate medications
provide the basis for the exercise Rx |
|
|
Term
| a patient in cardiac rehab should start at ___ METS and progress ___ MET per stage. |
|
Definition
|
|
Term
| what is the recommended frequency for a patient in cardiac rehab? |
|
Definition
| 3 days, but there is no reason they cannot do more, insurance will only pay for 3 days a week, multiple day sessions is ideal |
|
|
Term
| what is the recommended duration for patient in cardiac rehab? |
|
Definition
minimum of 15 minutes
most patients exercise 20-40 minutes |
|
|
Term
| the warm up for a cardiac rehab patient has been shown to___. |
|
Definition
| increase the time to the onset of angina |
|
|
Term
explain the intensity for someone in cardiac rehab?
what if there was no GXT? |
|
Definition
should start at 40/50% HRR
should start +20-30 beats above resting HR |
|
|
Term
| what are some important points for intensity for a patient in cardiac rehab? |
|
Definition
1)workload on the heart is determined by the product of the HR and SBP
2)HR & BP can vary greatly between different modes of exercise
3)inadequate warm-up may result in patient experiencing angina at lower HR than normal |
|
|
Term
| what are the limitations of using RPE to assess intensity for a patient in cardiac rehab? |
|
Definition
HR, BP and other may vary drastically between different modes of exercise at the same RPE
patients figure out very quickly what happens when they report a lower RPE |
|
|
Term
| what can be used to set the upper limit for a patient in cardiac rehab? |
|
Definition
1)onset of angina
2)plateau or decrease in SBP
3)>1mm ST-segment
4)radionucleide evidence of left ventricular dysfunction
5)increase frequency of arrhythmias
6)significant EEG disturbances
7)other signs and symptoms that limit exercise (non cardiac related) |
|
|
Term
| how would you progress an individual in cardiac rehab? |
|
Definition
if the patient cannot do 15 minutes of continuous exercise progress to 20-30 minutes
increase duration 10-30% per week |
|
|
Term
| why does chest pain delay with exercise? |
|
Definition
|
|
Term
| T/F you can increase duration and intensity in the same week. |
|
Definition
false
duration should be increased before intensity |
|
|
Term
| why is a prolonged cool down recommended? |
|
Definition
| to minimize risks of post-exercise hypotension and arrhythmias, not to mention DOMS |
|
|
Term
| can someone in cardiac rehab do strength training? |
|
Definition
only very light resistance
teach them to how the machines work |
|
|
Term
| what is the titration method? |
|
Definition
| add small amounts at the a time |
|
|
Term
| what are some ways to make strength training safer for patients in cardiac rehab? |
|
Definition
spot the person at the beginning as well as end of the lift
don't take the set to fatigue
perform exercise with one limb at a time
don't grip too tightly |
|
|
Term
| what are some examples of COPD? |
|
Definition
asthma
bronchitis
emphysema |
|
|
Term
| COPD is characterized by___. |
|
Definition
| expiratory flow limitations |
|
|
Term
| T/F 30 million people are diagnosed with COPD. |
|
Definition
|
|
Term
| T/F COPD is the 2nd leading reason for "at home" care after CHF. |
|
Definition
false
3rd leading cause after CHF and stroke |
|
|
Term
| T/F COPD patients are more likely to be admitted into the hospital compared with age and gender matched patients with other illnesses. |
|
Definition
|
|
Term
| T/F in 2011 was the 11th consecutive year in which men exceeded woman in he number of deaths due to COPD. |
|
Definition
|
|
Term
| T/F women are twice as likely to be diagnosed with chronic bronchitis than men. |
|
Definition
|
|
Term
| what is the estimated total economic cost of COPD in 2010? |
|
Definition
|
|
Term
| what is the leading cause of hospitalization in our aged population? |
|
Definition
|
|
Term
| T/F 51% of individuals say that their COPD limits their ability to do work. |
|
Definition
|
|
Term
asthma and EIA are characterized by reactivity to various stimuli such as:
reaction to these stimuli cause what? |
|
Definition
pollen or other allergens
pollution
cold or dry air
exercise or emotional stress
bronchospasm
excessive mucus production |
|
|
Term
explain asthma.
onset?
usual etiology?
course?
airflow limitation?
clinical features?
inflammatory cell?
responses to steroids? |
|
Definition
onset: anytime
usual etiology: immunologic stimuli, family history
course: usually intermittent
airflow limitation: largely reverse able
clinical features: wheeze, chest tightness, couch, dyspnea
inflammatory cell: marcophages
responses to steroids: inhibits inflammation |
|
|
Term
| what is bronchitis characterized by? |
|
Definition
chronic cough
excessive mucus production
enlargement of mucus glands
thickening of airway walls |
|
|
Term
| what is emphysema characterized by? |
|
Definition
loss of lung tissue
increased proteolytic activity
loss of lung elasticity
expiratory flow limitations
increase in Vd and impaired gas diffusion |
|
|
Term
| restrictive lung diseases are characterized by____. |
|
Definition
| decreased inspiratory flow or capacity |
|
|
Term
| give examples of restrictive diseases that effect the ribcage and the spine. |
|
Definition
kyphoscoliosis
anklyosing spondylitis |
|
|
Term
| give examples of restrictive diseases that effect the respiratory muscle and nerves. |
|
Definition
SCI
stroke
neuromuscular disorders |
|
|
Term
| give examples of restrictive lung diseases that effect the pleura. |
|
Definition
effusion
chronic pleuritis
pleural fibrosis |
|
|
Term
| give examples of restrictive lung diseases that effect the alveoli and parenchyma. |
|
Definition
interstitial fibrosis
alevolitis |
|
|
Term
| T/F obesity has an effect on the lungs as a restrictive disease. |
|
Definition
|
|
Term
spirometry of someone with COPD would have:
___TLC,
___FVC,
___RLV,
___IC,
___FEV1,
___FEV1/FVC ratio, and
___MVV.
what is the dead give away? |
|
Definition
normal or increased
modestly decreased
increased
decreased
markedly decreased
decreased
markedly decreased
DECREASED FEV1/FVC RATIO |
|
|
Term
spirometry of someone with restrictive lung disease would have:
___TLC,
___FVC,
___IC,
___FEV1,
___FEV1/FVC ratio, and
___MVV.
what is the dead give away? |
|
Definition
markedly decrease
markedly decrease
markedly decrease
modestly decreased
normal or above normal
modestly decreased
INCREASED FEV1/FVC RATIO |
|
|
Term
| someone with COPD would have ____ Ve, Ve/CO2 and Ve/O2 at rest and during exercise. |
|
Definition
|
|
Term
| T/F someone with COPD may reach the upper limits of MVV. |
|
Definition
|
|
Term
| someone with restrictive disease would have ____ Ve, Ve/CO2 and Ve/O2 at rest and during exercise. |
|
Definition
|
|
Term
| T/F someone with restrictive disease may reach the upper limits of IC. |
|
Definition
|
|
Term
| what are some commonly prescribed medications for someone with COPD? |
|
Definition
bronchodilator-theophylline
albuterol; prevents bronchospasm and symptoms of EIA,
cromolyn sodium: prevents chemical mediators from triggering asthma
corticosteroids: anti-inflammatories |
|
|
Term
| what medications protect patients in the late-phase COPD? |
|
Definition
bronchodilators
phosphodiesterase-4 inhibitors |
|
|
Term
| what medications protect patients in early-phase COPD? |
|
Definition
inflammatory mediators
antioxidants
antiproteases
retinoids |
|
|
Term
| what is Tiotropium? what does it do? |
|
Definition
new-generations anticholinergic agent
slows dissociation from the muscarinic receptor found on the bronchial smooth muscle |
|
|
Term
| what does a patient assessment include? (Hint: 10) |
|
Definition
1)patient interview
2)medical history
3)physical exam
4)diagnostic test
5)symptom assessement
6)musculoskeletal and exercise assessment
7)nutritional assessment
8)educational assessment
9)psychosocial assessment
10)goal development |
|
|
Term
| what are recommended tests for potential lung issues? |
|
Definition
spirometry
O2 saturation at rest and walking
chest radiograph
ECG
field test of exercise capacity
screening assessment of anxiety and depression
CBC |
|
|
Term
| what kind of exercise test would you put someone with lung issues though? |
|
Definition
mostly cycle test are performed but the test should look like everyday activities
GXTs
constant work rate tests |
|
|
Term
| what are the advantages of a simple walking test? disadvantage? |
|
Definition
simple and reproducible
learning effect must be controlled for
limited ability to measure physiological variables |
|
|
Term
| what are the advantages of GXT for someone with lung issues? disadvantages? |
|
Definition
the measurement of any physiological variable
more reliable
influenced by patient motivation
may be of limited use in severely disabled patients |
|
|
Term
| what are the advantages of constant work rate tests? disadvantages? |
|
Definition
allows for the measurement of physiological variables under the same conditions
useful as an adjunct to GXT
learning effect is a limitation |
|
|
Term
| T/F malnutrition is a problem in 20-30% of moderate to severe COPD patients. |
|
Definition
|
|
Term
| what BMI is associated with an increase overall mortality, independent of the degree of airway obstruction? |
|
Definition
|
|
Term
| hypoxia and hypercapnia, in relation to COPD____. |
|
Definition
| related to severe COPD and linked with malnutrition |
|
|
Term
| T/F overweight and even obesity are related to improved survival of patients with severe COPD. |
|
Definition
|
|
Term
| higher body weight correlates to better what? |
|
Definition
| exercise capabilities and diffusion capacity |
|
|
Term
| T/F obesity relates to a low FEV1. |
|
Definition
|
|
Term
| what are the points to goal development? |
|
Definition
establish short term and long term goals
realistic goals
involve significant others
assess goals frequently and change as needed
document progress to goals each session |
|
|
Term
| explain the mode for exercise Rx for patients with lung issues. |
|
Definition
aerobic exercise involving large muscle groups
strength training may help to maintain or increase muscle mass as well as improve strength and endurance |
|
|
Term
| T/F exercise involving upper body for patients with lung issues is ok. |
|
Definition
false
may increase respiratory demands/ distress |
|
|
Term
| what is the recommended frequency for patients with lung issues? |
|
Definition
|
|
Term
| what is the recommended duration for patients with lung issues? |
|
Definition
| progression to 20-30 minutes total exercise time using intermittent/interval training techniques |
|
|
Term
| what is the recommended intensity for patients with lung issues? |
|
Definition
no clear consensus
moderate intensity has shown improvements |
|
|
Term
| what is the best way to determine intensity in a patient with lung issues? |
|
Definition
ratings of dyspnea
O2 saturation |
|
|
Term
explain what each level on the dyspnea scale means.
1?
2?
3?
4? |
|
Definition
1-mild, noticeable to patient, not to observer
2-some difficulty, noticeable to observer
3-moderate difficulty, but can continue
4-severe difficulty patient cannot continue |
|
|
Term
| what should be incorporated into an exercise program for someone with lung issues? |
|
Definition
| controlled breathing techiques |
|
|
Term
| when would supplemental oxygen be necessary? |
|
Definition
| if a patient is desaturating |
|
|
Term
| what does CPAP stand for? what is it? what does it help to prevent? |
|
Definition
continuous positive airway pressure
reduces excessive elastic recoil associated with hyperinflation
reduces mechanical load on breathing muscles
prevents collapse of smaller airways |
|
|
Term
| what can pursed lip breathing help? |
|
Definition
| the maintenance of positive airway pressure |
|
|
Term
| what does UBRT stand for? what is it? are the results consistent? |
|
Definition
upper body resistance training
ADLs involving the upper body
no |
|
|
Term
| what does RIMT stand for? what cases has it been successful? |
|
Definition
resistive inspiratory muscle training
patients who don't respond to other therapy
patients with decreased respiratory muscle strength
absence of severe hyperinflation |
|
|
Term
| what are the benefits and goals of exercise training with someone with lung issues? |
|
Definition
improved aerobic capacity
increased muscle strength
improved ventilatory muscle strength
improved neuromuscular coordination
desensitization to dyspnea
reduced respiratory symptoms
achieve some degree of independence and significantly improve their quality of life |
|
|
